A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. (February 2021)

• Record Type: Journal Article
• Authors: Harwood, Rachel; Allin, Benjamin; Jones, Christine E; Whittaker, Elizabeth; Ramnarayan, Padmanabhan; Ramanan, Athimalaipet V; Kaleem, Musa; Tulloh, Robert; Peters, Mark J; Almond, Sarah; Davis, Peter J; Levin, Michael; Tometzki, Andrew; Faust, Saul N; Knight, Marian; Kenny, Simon; Agbeko, Rachel; Aragon, Octavio; Baird, Jim; Bamford, Alasdair; Bereford, Michael; Bharucha, Tara; Brogan, Paul; Butler, Karina; Carroll, Enitan; Cathie, Katrina; Chikermane, Ashish; Christie, Sharon; Clark, Matthew; Deri, Antigoni; Doherty, Conor; Drysdale, Simon; Duong, Phouc; Durairaj, Saravanan; Emonts, Marieke; Evans, Jennifer; Fraser, James; Hackett, Scott; Hague, Rosie; Heath, Paul; Herberg, Jethro; Ilina, Marina; Jay, Nicola; Kelly, Dominic; Kerrison, Caroline; Kraft, Jeannette; Leahy, Alice; Linney, Mike; Lyall, Hermione; McCann, Liza; McMaster, Paddy; Miller, Owen; O'Riordan, Sean; Owens, Stephen; Pain, Clare; Patel, Sanjay; Pathan, Nazima; Pauling, James; Porter, David; Prendergast, Andrew; Ravi, Kumar; Riorden, Andrew; Roderick, Marion; Scholefield, Barnaby R; Semple, Malcolm G; Sen, Ethan; Shackley, Fiona; Sinha, Ian; Tibby, Shane; Verganano, Stefania; Welch, Steven B; Wilkinson, Nicholas; Wood, Mark; Yardley, Iain;
• Is Part Of: Lancet. Volume 5:Number 2(2021)
• Page Start: 133
• Page End: 141
• Publication Date: 2021-02
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; Adolescent medicine -- Periodicals; Teenagers -- Health and hygiene -- Periodicals; 618.920005
• DOI: 10.1016/S2352-4642(20)30304-7
• Languages: English
• ISSNs: 2352-4642

Abstract

Summary: Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a novel condition that was first reported in April, 2020. We aimed to develop a national consensus management pathway for the UK to provide guidance for clinicians caring for children with PIMS-TS. A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management, and research priorities from multidisciplinary clinicians caring for children with PIMS-TS. We used 140 consensus statements to derive a consensus management pathway that describes the initial investigation of children with suspected PIMS-TS, including blood markers to help determine the severity of disease, an echocardiogram, and a viral and septic screen to exclude other infectious causes of illness. The importance of a multidisciplinary team in decision making for children with PIMS-TS is highlighted throughout the guidance, along with the recommended treatment options, including supportive care, intravenous immunoglobulin, methylprednisolone, and biological therapies. These include IL-1 antagonists (eg, anakinra), IL-6 receptor blockers (eg, tocilizumab), and anti-TNF agents (eg, infliximab) for children with Kawasaki disease-like phenotype and non-specific presentations. Use of a rapid online Delphi process has made it possible to generate a national consensus pathway in a timely and cost-efficient manner in the middle of a global pandemic. The consensus statements represent the views of UK clinicians and are applicable to children in the UK suspected of having PIMS-TS. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS. This process has directly informed new PIMS-TS specific treatment groups as part of the adaptive UK RECOVERY trial protocol, which is the first formal randomised controlled trial of therapies for PIMS-TS globally.